Mitch’s posterous

Let's keep one central fact in mind about health care.  The USA is the ONLY developed country in the world that doesn't provide health care coverage for all of its citizens.  This is shameful and has to be fixed.  Paul Krugman's  NYT op-ed today reviews three principal ways other nations fullfil their basic responsibilities.

(1) Government owns and operates the health care system, like the U.K.

(2) Health care is delivered in a private system, but government pays most of the bills, as in Canada and France.

(3) There is a private system for providing health care and paying for it through insurance, which uses regulation and incentives to achieve coverage goals, like Switzerland.

The approach we're likely to see is somewhere between a weak form of #2 (private insurance with a public option) and #3.  As of this writing, it is beginning to look like the public option is off the table for lack of support.  As Krugman points out, there's no chance we'll wind up like the U.K. (which is not to say the U.K. system is a bad one).  We might wind up like the Swiss and, with one huge exception, this would not be such a bad thing.

Achieving universal coverage per se does nothing to contain the escalating cost of providing that care.  Without getting costs under control, the system will be completely unsustainable.   Comprehensive health care reform requires changing the economic incentives away from fee-for-service and toward paying for results.  If anything, this is going to be more difficult than achieving universal coverage.  I hope to have more to say about this soon.